Ventilator Liberation: Evaluating Staff Perceptions of Practice and Policy Adherence

Major critical care organizations advocate for combined spontaneous awakening and breathing trials to expedite ventilator liberation and minimize the complications associated with prolonged intubation. Evaluating staff perceptions of ventilator liberation may enhance protocol changes and implementation. To assess staff perceptions of ventilator weaning practices, barriers to timely extubation, and potential organizational improvements in a Midwest regional health care system. In an exploratory, cross-sectional study, a 29-question survey was administered to 91 licensed staff in 6 intensive care units to assess demographics, extubation practices, extubation delays, and opportunities for improvement. Means and SDs were used to describe continuous variables; frequencies and percentages were used to describe categorical variables. Chi-square tests were used to evaluate occupational differences, and 2 investigators independently coded responses to identify themes and resolve discrepancies through discussion and consensus. More than half of the 91 respondents reported high comfort with ventilator liberation. More than 60% perceived extubation timing as being longer than ideal. Respondents identified staffing ratios, communication failures, distractions, and sedation weaning practices as factors delaying extubation. Identified improvement opportunities were protocol development, enhanced practices related to the roles of critical care physicians and advanced practice providers, and better staff education. The survey highlighted staff opinions on ventilator liberation and key improvement factors. Addressing staff concerns will aid in refining organizational policies to improve patient and organizational outcomes.